{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:52:05Z","timestamp":1772211125424,"version":"3.50.1"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Decompressive craniectomy (DC) seemed to reduce the risk of death or profound disability (modified Rankin Scale score, 5\u20136) after deep intracerebral hemorrhage (ICH) by an absolute 13% (95% CI, 0%\u201326%) in the SWITCH trial (Swiss Trial of Decompressive Craniectomy versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage). Whether the effect of DC differs by ICH location is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Post hoc analysis of participants with supratentorial severe deep ICH from the intention-to-treat population of the SWITCH randomized controlled trial. We categorized ICH as involving (1) the basal ganglia (BG) alone, (2) BG and the posterior limb of the internal capsule (PLIC), or (3) BG, PLIC, and thalamus. We examined the interaction between ICH location and DC\u2019s effect on primary (modified Rankin Scale score, 5\u20136) and secondary outcomes (death; full modified Rankin Scale score range) at 180 days using unadjusted and adjusted logistic or survival models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 197 participants comprising the trial\u2019s intention-to-treat population, 184 were available for analysis (median age, 61 years; 59 women; 91 randomized to DC plus best medical treatment; and 93 to best medical treatment). ICH involved BG alone in 26 (14%), BG+PLIC in 94 (51%), and BG+PLIC+thalamus in 64 participants (35%). The marginal risk of the primary outcome after adjustment for age, ICH severity, and volume was lower with DC by 15.6% (95% CI, \u221249.2% to 18.1%) in participants with ICH of BG alone, by 11.4% (\u221229.3% to 6.6%) in those with ICH of BG+PLIC, and by 9% (\u221231% to 12.9%) in those with ICH of BG+PLIC+thalamus, without evidence for treatment-by-location interaction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.95). Secondary outcome analyses yielded consistent results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The potential benefits of DC seemed preserved regardless of the location of severe deep ICH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02258919.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.052460","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T09:00:14Z","timestamp":1760691614000},"page":"12-19","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Effect of Decompressive Craniectomy According to Location of Deep Intracerebral Hemorrhage: A SWITCH Trial Analysis"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct02258919","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-2208","authenticated-orcid":true,"given":"Alexandros A.","family":"Polymeris","sequence":"first","affiliation":[{"name":"Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (A.A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7962-143X","authenticated-orcid":true,"given":"Matthias F.","family":"Lang","sequence":"additional","affiliation":[{"name":"University Institute of Diagnostic and Interventional Neuroradiology (M.F.L., A.H.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9431-1069","authenticated-orcid":true,"given":"Arsany","family":"Hakim","sequence":"additional","affiliation":[{"name":"University Institute of Diagnostic and Interventional Neuroradiology (M.F.L., A.H.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"B\u00fctikofer","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, University of Bern, Switzerland (L.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8709-5932","authenticated-orcid":true,"given":"Christian","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center\u2013University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (C.F., R.R., J.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3057-882X","authenticated-orcid":true,"given":"Seraina","family":"Beyeler","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.B., W.Z.G., B.S., D.J.S., U.F.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5684-4419","authenticated-orcid":true,"given":"Werner","family":"Z\u2019Graggen","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.B., W.Z.G., B.S., D.J.S., U.F.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-2344","authenticated-orcid":true,"given":"Daniel","family":"Strbian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland (D.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4350-392X","authenticated-orcid":true,"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, Germany (P.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-6042","authenticated-orcid":true,"given":"Gerrit A.","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital RWTH, Aachen, Germany (G.A.S.)."},{"name":"Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland (G.A.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0102-1765","authenticated-orcid":true,"given":"Andreas","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kepler University Hospital, Johannes Kepler University, Linz, Austria (A.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1462-4864","authenticated-orcid":true,"given":"Dorothee","family":"Mielke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Goettingen, Germany (D.M.)."},{"name":"Department of Neurosurgery, University Hospital Augsburg, Germany (D.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0985-7583","authenticated-orcid":true,"given":"Roland","family":"Roelz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center\u2013University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (C.F., R.R., J.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0240-4191","authenticated-orcid":true,"given":"Bernhard","family":"Siepen","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.B., W.Z.G., B.S., D.J.S., U.F.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-3849","authenticated-orcid":true,"given":"David J.","family":"Seiffge","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.B., W.Z.G., B.S., D.J.S., U.F.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1936-3173","authenticated-orcid":true,"given":"Magdy H.","family":"Selim","sequence":"additional","affiliation":[{"name":"Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.A.P., M.H.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3886-466X","authenticated-orcid":true,"given":"Andreas","family":"Raabe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (W.Z.G., A.R.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7687-6098","authenticated-orcid":true,"given":"J\u00fcrgen","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center\u2013University of Freiburg, Faculty of Medicine, University of Freiburg, Germany (C.F., R.R., J.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-4051","authenticated-orcid":true,"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.B., W.Z.G., B.S., D.J.S., U.F.), Inselspital, Bern University Hospital and University of Bern, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the SWITCH Study 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